This document, issued jointly with the Public Health Collaboration, has achieved Worldwide coverage over the past week. It was co-authored by Aseem Malhotra, NHS consultant cardiologist and NOF adviser, David Haslam, GP Watton-at-Stone, Sam Feltham, director of the Public Health Collaboration, David Unwin, GP Southport, and Shamil Chandaria, Patron, NOF, Jason Fung, , Nephrologist and Chief of the Department of Medicine, The Scarborough Hospital, Toronto, Canada, James DiNicolantonio, Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute, Trudi Deakin, Dietitian and best selling author, Caryn Zinn Dietitian, Auckland, New Zealand, and Peter Brukner, OAM, MBBS, FACSP, FACSM, FASMF, FFSEM; specialist sports and exercise physician . No funding was sought or received for this report. The document was supported and peer reviewed by an International expert panel[i][i].
The approach described in the document is nothing new, and the wording is deliberately phrased in respect to Hippocrates, the Father of Medicine who recommended ‘rich foods’ to stay thin, including fatty meats, especially grassfed animals. The arguments surrounding fats and carbohydrate have been vigorous ever since. The treatment of diabetes in particular has been controversial over many centuries. In the 17th century physicians such as Thomas Willis considered diabetes to be a disorder of the kidneys which leaked sugar; treatment was to replace the lost sugar with a high sugar diet. In the late 18th century John Rollo defined the underlying cause of diabetes as being the gastro-intestinal tract by varying macronutrients in the diet, and boiling down 24 hour urine specimens to measure the sugar therein; the lower the starch in the diet, the less sugar he found in the urine. Many great physicians espoused the low carb, higher fat approach over the next 150 years, culminating in classic texts such as Raymond Greene’s essential The Practice of Endocrinology which states that the diet for obesity is to avoid bread, flour, cereals, potatoes, sugar and sweets in favour of meat, fish and birds; green vegetables, eggs, cheese and certain fruit – a very similar method to that described in the report. There is a growing portfolio of recent evidence supporting the benefits of ad libitum low carbohydrate approaches.
Reactions to the report.
Predictably our document has polarised opinion, hence the need for this statement.
Professor Phillip James said: ”Unfortunately the human body developed in evolutionary terms the most duplicated rigorous and complex systems for keeping us from starvation so a glib series of one liners does not sort the obesity problem out - hence our failure so far.” and that the report “takes as read things like dietary cohort studies which are almost all fundamentally flawed with their measurement errors - particularly on fat% - and the failure to understand the individual , usually genetic, differences in responsiveness that we have seen in almost every biological response we have looked at.”
Professor Mike Lean, rather succinctly said: “Frankly, you have blown it”
Pinki Sahota, Chair of ASO, on behalf of ASO said “The ASO, established [in](sic) 1967 is dedicated to the understanding, prevention and treatment of obesity. ASO is a scientific society and we support and promote an evidence based approach through the pursuit of excellence in research, education and practice. As such we do not endorse the content of the report as it contradicts current evidence based advice on healthy eating with a potential detrimental impact on public health”
Various other experts, however, have been generous in their support.
Professor Iain Broom wrote: “At long last there is some sense coming into dietary advice that may eventually lead to improved health, in particular tackling the double whammy of obesity and Type 2 Diabetes Mellitus. I totally agree with the document produced jointly by the NOF and the Public Health Collaboration” although correctly pointing out that we should have said ‘zero added sugar’, rather than ‘zero sugar’ as healthy fruit contain sugars.
Professor Robert Lustig, Professor of Paediatrics, Division of Endocrinology and Member, Institute for Health Policy Studies, University of California, San Francisco and President, Institute of Responsible Nutrition advised that: “this new National Obesity Forum and Public Health Collaboration guideline focuses on real food over processed food, and makes the case that the entire healthcare complex needs to relearn nutrition in order to be effective advocates for their patients. I couldn’t agree more.”
Professor Ian Banks, President of the European Men’s Health forum, praised the ‘superb report’.
The rest of the Board of the NOF wish to make it completely and transparently clear that they were not given the opportunity to see the document, or give any input into it and some members opinions differ from those specifically presented in the document. The Board has stated, regarding the document, "the NOF is a forum that welcomes debate and discussion, even when opinions differ or challenge widely held beliefs. This paper has some interesting arguments for future discussion, some of which are the opinions of the authors, and not all of the Board Members. Though individuals’ opinions differ within the Forum, as a group however, the NOF supports the principle of discussion and therefore the right of those named authors to produce an opinion paper based on their own views without prejudice or penalty. At the same time, the Forum recognises that NOF agents and associates, other Board Members and individual NOF members may have differing views from some points raised in this document and retain the right to those views also without prejudice or penalty within the freedom of a forum. For further information regarding this document, enquiries should be directed to the authors."
[i][i] Dr Zoe Harcombe, Obesity researcher. Professor Robert Lustig, Professor of Paediatrics, Division of Endocrinology and Member, Institute for Health Policy Studies, University of California, San Francisco Dr Jason Fung, Nephrologist and Chief of the Department of Medicine, The Scarborough Hospital, Toronto, Canada. Dr James Di-Nicolantonio, Cardiovascular research scientist, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA Dr Eric Westman, President of the American Society of Bariatric Physicians Dr Michael and Dr Mary Eades, California, USA. Professor Timothy Noakes, Emeritus Professor of Sports Medicine and Exercise Science, University of Cape Town Mrs Karen Thomson, Best-selling author and health activist. Dr Caryn Zinn, Dietician and Senior Lecturer, Auckland University of Technology, New Zealand Professor Grant Schofield, Professor of Public Health, Auckland University of Technology, New Zealand Professor Peter Brukner, Sport and Exercise Medicine Physician, Australian Cricket Team Doctor, Professor of Sports Medicine, La Trobe University Dr Ross Walker, Cardiologist, Lindfield Cardiology, Sydney Australia Damon Gameau, Film maker and health activist, Melbourne, Australia Christine Cronau, Nutritionist and best-selling author, Brisbane, Australia Caitlin Dalton, Nutritionist, Brisbane, Australia.